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Biomedical subjects

Michael Dan

Publications and source records attributed to Michael Dan.

At least 19 recordsLinked to original sources
PubMed2006

The VI-SENSE-vaginal discharge self-test to facilitate management of vaginal symptoms.

OBJECTIVE: This study was undertaken to evaluate a diagnostic panty liner (VI-SENSE) (Common Sense, Caesarea, Israel) developed to facilitate diagnosis of vaginal infections by detecting disordered acidity level. STUDY DESIGN: Five hundred sixteen women with vulvovaginal symptoms were enrolled. Final clinical diagnosis included Amsel criteria, Gram stain analysis, pH determination, and Trichomonas vaginalis and Candida culture. VI-SENSE strip color status estimated by patients was compared with clinical diagnosis and pH measurement by using nitrazine paper. Statistical analysis included sensitivity and specificity calculations. RESULTS: The VI-SENSE test was positive in 226 of 249 patients (90.8%) with bacterial vaginosis or trichomoniasis. Nitrazine pH paper revealed elevated pH in 165 (66.5%) and the amine test was positive in 160 (64.3%) patients. The VI-SENSE test was negative in 217 of 267 patients (81.3%) without trichomoniasis or bacterial vaginosis. The VI-SENSE was positive in 85 of 92 women (92%), with mixed vaginal infection including Candida and bacterial vaginosis or trichomoniasis. Amine test, nitrazine pH paper and physician diagnosis relying only on speculum examination were inferior and positive in only 65 (70%), 59 (64%), and 66 (72%) patients, respectively. CONCLUSION: The VI-SENSE test was found to be superior to traditional individual tests in facilitating preliminary diagnosis of vaginal infections.

Adult↗
PubMed2006

Phialemonium curvatum arthritis of the knee following intra-articular injection of a corticosteroid.

Phialemonium curvatum arthritis of the knee developed in a diabetic man following intra-articular injection of a corticosteroid. Cure was achieved with a 6-week course of intravenous amphotericin B deoxycholate. P.curvatum is commonly found in the environment and is often considered a contaminant; yet, its pathogenic potential should be seriously considered in selected patients.

Adrenal Cortex Hormones↗
PubMed2006

Pharyngeal Gonorrhea in female sex workers: Response to a single 2-g dose of azithromycin.

OBJECTIVES: A sharp increase in the incidence of gonorrhea has been observed in Tel Aviv, Israel, since 1999. Almost one half of interviewed patients admitted contracting the infection from a sex worker. In two thirds of the cases, oral sex (fellatio) was the most probable route of acquiring the disease. In the current study, we assessed the prevalence of pharyngeal gonorrhea among sex workers in Tel Aviv and evaluated the efficacy of a single 2-g dose of azithromycin in eradicating the infection. METHODS: Throat specimens were obtained for gonococcal culture from 301 female sex workers practicing in brothels. A questionnaire covering demographic and sexual behavior information was administered to all participants, and a single 2-g dose was administered orally under supervision. Women with positive cultures were reexamined a week later for eradication of Neisseria gonorrhoeae. RESULTS: N gonorrhoeae was isolated from 27 women (9%). The median age of women with pharyngeal gonorrhea was 23 years (range, 18-32 years); 85% were born in former Soviet Union (mostly Russia, Ukraine, Moldavia). Regular condom use in vaginal sex was reported by 88% of the participants, whereas only 60% reported always using condoms in oral sex. All isolates were susceptible to azithromycin (MIC < or = 0.5 microg/ml). Gonococci were eradicated in 20/21 individuals (95%). CONCLUSION: A high carriage rate of gonococci in the throat and a low rate of condom use in oral sex were documented among sex workers in Tel Aviv. A single 2 g dose of azithromycin was very effective in eradicating gonococci from the throat.

Adolescent↗
PubMed2006

Pathogenic colonization of the stomach in enterally fed elderly patients: Comparing percutaneous endoscopic gastrostomy with nasogastric tube.

OBJECTIVES: To compare the gastric juice microbiota of older people fed through a percutaneous endoscopic gastrostomy tube (PEG) with that of those fed through a nasogastric tube (NGT). DESIGN: Prospective comparative study. SETTING: Nursing and skilled nursing wards. PARTICIPANTS: Fifty-four elderly PEG-fed and 52 NGT-fed patients. MEASUREMENTS: Cultures from the oropharynx and the gastric juice. RESULTS: Pathogenic bacteria were isolated from the oropharynxes of 44% of the PEG-fed patients and 54% of the NGT-fed patients. The most frequent gram-negative bacilli isolated from the oropharynx were Proteus spp. (13-21%) and Pseudomonas aeruginosa (13-18%), with no significant difference between the groups. Isolation rates from the gastric juice were significantly more frequent in the NGT-fed patients than in the PEG-fed patients for Proteus spp. (4% vs 23%), Escherichia coli (6% vs 21%), and mixed flora (11% vs 27%). Significant correlation was found between high gastric pH and the isolation of bacteria in both groups (correlation coefficient = 0.58, P < .001). CONCLUSION: Gastric juice of PEG-fed patients harbors pathogenic bacteria in significant numbers. No significant difference was noted with respect to the rate of isolation of pathogenic bacteria from the oropharynx between the groups. Major bacterial pathogens, such as P. aeruginosa and Proteus spp., were isolated significantly more from the gastric juice of NGT-fed patients. These results support the view that a bidirectional spread pattern of pathogens may take place in NGT-fed patients.

Aged↗
PubMed2006

Epidemiology and clinical aspects of enteric fever in Israel.

Enteric fever decreased in Israel in the last 50 years, but its current epidemiology is unknown. In a nationwide study, we evaluated all cases of enteric fever from 1995 to 2003. On hundred thirty-six cases met the case definition. During the period studied, the incidence of enteric fever decreased from 0.42 to 0.23/100,000. A total of 57.4% of the cases were acquired abroad. The incidence of endemic enteric fever was 2.7 times higher in Arabs than in Jews. In Arabs, Salmonella Typhi was the causative agent in all cases, and almost all cases were endemic. In Jews, most cases were imported, with a decrease in imported S. typhi, cases and an increase in imported S. Paratyphi A cases. Salmonella Paratyphi B was endemic, and restricted to the Jewish population. The reasons for the difference in causative agents along ethnic lines need further evaluation. A more efficient vaccine for travelers that includes S. Paratyphi A is needed.

Adolescent↗
PubMed2005

[Sexually transmitted diseases--an update].

Sexually transmitted infections represent an worldwide challenge for the public health. According to WHO estimates, approximately 330 million people are infected annually by curable sexually transmitted infections (AIDS excluded). and their incidence has been increasing, particularly in high-risk populations. Like in other developed countries, the occurrence of venereal diseases in Israel has been increasing recently. In addition, a sharp rise has been observed in the resistance rate of gonococci to fluoroquinolones. The purpose of the present review is to update the information on the epidemiology, diagnosis, therapy and prevention of sexually transmitted diseases (STDs) in Israel. In response to the reemergence of these diseases in Israel, it was decided in the Ministry of Health to open for the first time ever STD clinics in the two cities with the highest disease burden, namely Tel Aviv and Haifa. These clinics are staffed with a multidisciplinary group of specialists, including gynecologists, dermatologists, epidemiologists, nurses and social workers.

Female↗
PubMed2005

Malaria in travelers returning from short organized tours to holiday resorts in Mombassa, Kenya.

BACKGROUND: Short trips to holiday resorts in Mombassa, Kenya, have gained popularity among Israelis since the early 1990s. A cluster of cases of malaria among returned travelers raised concern that preventive measures were being neglected. OBJECTIVES: To characterize the demographic and clinical features of malaria acquired in Kenya, and to assess the adequacy of preventive measures. METHODS: Data were collected from investigation forms at the Ministry of Health. All persons who acquired malaria in Kenya during the years 1999-2001 were contacted by phone and questioned about use of chemoprophylaxis, attitudes towards malaria prevention, and disease course. Further information was extracted from hospital records. RESULTS: Kenya accounted for 30 (18%) of 169 cases of malaria imported to Israel and was the leading source of malaria in the study period. Of 30 malaria cases imported from Kenya, 29 occurred after short (1-2 weeks) travel to holiday resorts in Mombassa. Average patient age was 43 +/- 12 years, which is older than average for travelers to tropical countries. Only 10% of the patients were fully compliant with malaria chemoprophylaxis. The most common reason for non-compliance was the belief that a short trip to a holiday resort carries a negligible risk of malaria. Only 3 of 13 patients (23%) who consulted their primary physician about post-travel fever were correctly diagnosed with malaria. Twenty percent of cases were severe enough to warrant admission to an intensive care unit; one case was fatal. CONCLUSIONS: Measures aimed at preventing malaria and its severe sequelae among travelers should concentrate on increasing awareness of risks and compliance with malaria chemoprophylaxis.

Adult↗
PubMed2004

Quinolone resistance-determining region mutations and por type of Neisseria gonorrhoeae isolates: resistance surveillance and typing by molecular methodologies.

Quinolone resistance is increasing rapidly in Neisseria gonorrhoeae and is a significant public health problem that requires ongoing surveillance. To examine the feasibility of molecular surveillance of quinolone resistance, and to further characterize an outbreak of resistant N. gonorrhoeae in Israel, the quinolone resistance-determining region (QRDR) sequences and the por types of 80 N. gonorrhoeae isolates were determined using molecular techniques. QRDRs of gyrA and parC were amplified by polymerase chain reaction and were sequenced directly. The por type was determined by checkerboard hybridizations performed using oligonucleotide probes to regions encoding 5 variable loops of the porin protein. All 42 ciprofloxacin-resistant (CipR) isolates had mutations in QRDRs of both gyrA and parC, and identical mutations were found in 93% of these isolates. One intermediately resistant isolate had 1 mutation in gyrA, and susceptible isolates showed no mutations. Forty isolates had 1 of 2 por types that differed only by an in-frame deletion in variable region 5; all but 1 of these isolates were CipR. QRDR sequencing and por type determination showed that the outbreak of CipR N. gonorrhoeae in Israel was clonal. QRDR mutations were consistent with those previously characterized; this indicates that DNA probes can be developed for rapid detection and surveillance of quinolone-resistant N. gonorrhoeae in settings in which nonculture diagnostic methods are used.

Anti-Infective Agents↗
PubMed2004

Use of applied biosystems 7900HT sequence detection system and Taqman assay for detection of quinolone-resistant Neisseria gonorrhoeae.

Mutations in quinolone resistance-determining regions (QRDRs) have been associated with quinolone-resistant Neisseria gonorrhoeae (QRNG). Since diagnostic nucleic acid amplification tests for gonococci are now in frequent use, molecular detection of QRNG could facilitate surveillance in the absence of culture. Here we describe a real-time molecular assay for detecting QRDR mutations in gonococci.

Ciprofloxacin↗
PubMed2004

The use of fluoroquinolones in gonorrhoea: the increasing problem of resistance.

The recent re-emergence of gonorrhoea in developed countries has been accompanied by the rise and spread of gonococcal resistance to the fluoroquinolones. In the 1980s fluoroquinolones were considered an important addition to the arsenal of agents used to treat gonorrhoea. They proved to be excellent drugs for this indication, including infections caused by penicillinase-producing and tetracycline-resistant strains of Neisseria gonorrhoeae. However, as gonococci have a well-recognised potential to develop resistance to antibiotics, the first reports of reduced susceptibility to fluoroquinolones appeared a few years after their introduction. Gonococcal resistance to fluoroquinolones is now well-established in the Far East, from where it has spread to Australia, Hawaii, California and Europe. In Africa and Latin America, gonococci continue to be susceptible to fluoroquinolones.

Clinical Trials as Topic↗
PubMed2004

Opisthorchiasis from imported raw fish.

Liver fluke infection caused by Opisthorchiidae is a major public health problem in many parts of the Far East, Southeast Asia, and eastern Europe. However, with the growing volume of international travel and population migration, the infection is increasingly diagnosed in countries where the disease is not endemic, particularly in North America. We report an outbreak of acute opisthorchiasis in a family that was infected in a non-disease-endemic area after eating raw carp illegally imported from a highly disease-endemic area in Siberia. With the growing numbers of former Soviet Union citizens immigrating to other countries, western physicians need to be alert regarding Opisthorchis-associated pathology in this population. The epidemiology and biology of Opisthorchiidae in the former Soviet Union are reviewed.

Animals↗
PubMed2004

Can it be TB?

Explore the source record for details and available documents.

Emigration and Immigration↗
PubMed2003

Herpes simplex virus type 1 is the prevailing cause of genital herpes in the Tel Aviv area, Israel.

BACKGROUND AND GOAL: The changing epidemiology of genital herpes with the increasing importance of herpes simplex virus (HSV) type 1 prompted a study on the relative prevalence of HSV-1 and HSV-2 among cases of genital herpes in the Tel Aviv area, Israel. STUDY DESIGN: A retrospective laboratory-based study of positive genital and nongenital herpes cultures performed at the Beilinson Medical Center between 1993 and 2002. Data regarding the number of isolates of each type and the age and sex of patients with genital lesions were retrieved from the database. Cultures were performed using Vero cells, and positive results were confirmed and typed by immunofluorescence. RESULTS: A total of 285 positive genital cultures and 659 positive nongenital cultures were recorded. HSV-1 was identified in 189 (66.3%) of the positive genital specimens and in 656 (99.55%) of the nongenital specimens. HSV-1 was isolated in 174 of 262 (66.4%) female subjects and 15 of 23 (65.2%) male subjects. The proportion of HSV-1 genital isolates was 72.7% in patients 15 to 24 years of age, 62% in those 25 to 44 years, and 46% in those aged 45 years or older. Overall, the annual isolation rate of genital HSV-1 has not changed markedly over the years. CONCLUSION: Herpes simplex virus type 1 has clearly been the predominant HSV type isolated from genital specimens in the Tel Aviv area over the last decade.

Adolescent↗
PubMed2003

Prevalence and risk factors for herpes simplex virus type 2 infection among pregnant women in Israel.

BACKGROUND: Although usually a nuisance to the adult patient, herpes simplex virus type 2 (HSV-2) infection can have devastating consequences on the infected newborn. It is thus important to document the prevalence and risk factors of this infection among pregnant women in a defined population. The availability of the new type-specific assays that provide accurate serologic results prompted us to study the seroprevalence of HSV-2 infection among pregnant women in Israel. STUDY DESIGN: In a cross-sectional descriptive study, 512 pregnant women were tested. The study population included Israeli-born Jewish and Arab women, and new immigrants from the former Soviet Union. A competition-based enzyme-linked immunosorbent assay (ELISA) was used to detect type-specific HSV-1 and HSV-2 antibodies. Univariate and multivariate analyses were performed to identify risk factors for HSV-2 seropositivity. RESULTS: The prevalence of HSV-2 infection was 13.3% (95% confidence interval, 10.5-16.5%) and that of HSV-1 was 94.9%. History of genital or labial herpes was reported by 1.3% and 26.8% of the participants, respectively. The HSV-2 infection rate was 3-fold higher among immigrants from the former Soviet Union (27.5%) than among Israeli-born Jewish and Arab women (9%). The only risk factor independently associated with HSV-2 seropositivity was multiple lifetime sexual partners. CONCLUSION: We have documented a relatively low seroprevalence of HSV-2 infection in a demographically mixed group of pregnant women in Israel. The role of high-risk sexual behavior in the spread of the infection has been reconfirmed.

Adolescent↗
PubMed2003

Pseudomonas aeruginosa and the oropharyngeal ecosystem of tube-fed patients.

We evaluated whether elderly patients fed with nasogastric tubes (NGT) are predisposed to Pseudomonas aeruginosa colonization in the oropharynx. Fifty-three patients on NGT feeding and 50 orally fed controls with similar clinical characteristics were studied. The tongue dorsum was swabbed and cultured. P. aeruginosa was isolated in 18 (34%) of the NGT-fed group but in no controls (p<0.001). Other gram-negative bacteria were cultured from 34 (64%) of NGT-fed patients as compared with 4 (8%) of controls (p<0.001). Antibiotic susceptibility of the oropharyngeal P. aeruginosa isolates was compared with that of isolates from sputum cultures obtained from our hospital's bacteriologic laboratory. The oropharyngeal isolates showed a higher rate of resistance; differences were significant for amikacin (p<0.03). Scanning electron microscope studies showed a biofilm containing P. aeruginosa organisms. The pulsed-field gel electrophoresis profile of these organisms was similar to that of P. aeruginosa isolates from the oropharynx. NGT-fed patients may serve as vectors of resistant P. aeruginosa strains.

Aged↗
PubMed2003

Vaginitis in a gynecologic practice in Israel: causes and risk factors.

BACKGROUND: Vaginal symptoms are a leading reason for a patient to visit her gynecologist. Little is known about the prevalence of the different causes of vaginitis and the risk factors for this entity in Israel. OBJECTIVE: To determine the prevalence of the main forms of vaginitis: vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis, in a gynecologic practice in Israel. METHODS: We evaluated 208 patients presenting with vaginal symptoms to a gynecologic clinic; 100 asymptomatic women who attended the clinic for routine check-up served as controls. Demographic, medical and gynecologic histories were obtained, and a pelvic examination was performed in all patients. Vaginal specimens were tested for pH and amine reaction, smeared for Gram-staining and cultured for yeasts and Trichomonas vaginalis. Bacterial vaginitis was diagnosed using the Nugent scoring system. Candida infection was diagnosed by microscopic examination and by culture. RESULTS: Candida spp. was the most common pathogen, documented by microscopy and culture in 35.5% of symptomatic women and 15% of asymptomatic controls (P < 0.001). Detection by culture only (negative microscopy) was documented in 18.7% of symptomatic patients and 15% of controls (P = 0.5). Bacterial vaginosis (Nugent score > or = 7) was diagnosed in 23.5% of patients and 13% of controls (P = 0.04). Trichomoniasis was present in 8.1% of symptomatic women and 4% of controls (P = 0.1). The main risk factors were antibiotic use for candidiasis and lack of use of oral contraception and condom use for trichomoniasis. CONCLUSION: Candida was by far the most common pathogen detected in our population. A statistically significant difference between patients and controls was noted for the prevalence of microscopically diagnosed candidiasis and bacterial vaginosis.

Adult↗